| Background and objectives:Acute coronary syndrome(ACS)is associated with acute myocardial ischemia and life-threatening disease.There are three main types of ACS:ST segment elevation myocardial infarction(STEMI),non-ST segment elevation myocardial infarction(NSTEMI)and unstable angina(UA).Treatment includes medications and revascularization.PCI therapy can effectively relieve symptoms and improve short-term prognosis.In order to improve the long-term prognosis of patients with acute coronary syndrome after PCI,it is necessary to strengthen the secondary prevention of coronary heart disease.Currently there are a lot of evidence-based medicine evidences suggesting that the long-term standardized therapy for secondary prevention of coronary heart disease can delay and reverse the process of coronary atherosclerosis,as well as reduce the major adverse cardiac events(MACE)in patients with acute coronary syndrome.Although there is no doubt that secondary prevention of coronary heart disease is important for outcomes of pationts with acute coronary syndrome after percutaneous coronary intervention,there are a large number of studies showing that the utilization of secondary prevention drugs in patients with acute coronary syndrome after percutaneous coronary intervention is not sufficient.The study objectives were to assess the gap between the use of evidence-based secondary prevention medications at discharge among patients with acute coronary syndrome undergoing percutaneous coronary intervention in qilu Hospital of Shandong University and the guidelines recommendation and to determine the relationship between patients medication regimen adherence and the decrease in the incidence rate of the major adverse cardiac events.Analyze the relevent factors that affect patient compliance and provide a basis for developing strategies to improve patient medication adherence.Methods:Collect the basic information of patients with acute coronary syndrome undergoing percutaneous coronary intervention in qilu Hospital of Shandong University during 2015,including patients age,gender,nationality,birthplace,occupation,marital status,education,method of payment,contact,smoking history,drinking history,family history,height,weight,blood pressure,medical history,medications,examinations and surgery,and more.Investigate the usages of evidence-based secondary prevention medications and the incidence rates of the major adverse cardiac events in patients who meet the inclusion criteria during a month,three months,six months and 12 months after discharge.According to patients medication adherence during the follow-up period,a total of 615 enrollment patients were assigned to two groups,including the standard group(n=297)and non-standard group(n=318).Then,conduct statistical analysis about the use of evidence-based secondary prevention medications and the major adverse cardiac events during the follow-up period.The influence of related factors on the patients medication compliance was analyzed by multivariate Logistic regression analysis.Results:A total of 615 enrollment patients were selected based on inclusion and exclusion criteria,including the standard group(n=297)and non-standard group(n=318).Gender,age,hospitalization,disease classification,systolic blood pressure,diastolic blood pressure,blood glucose,blood lipids,hypertension and diabetes,smoking history and the number of stent between two groups were all no statistical differences(p>0.05).At discharge,patients were prescribed the following:aspirin 609 cases(99.0%),the P2Y12 receptor inhibitor 590 cases(95.9%),statin 586 cases(95.3%),?-blockers 455 cases(74.0%),ACEI/ARB 307 cases(49.9%).The most prescribed class of medicines at discharge was aspirin(99.0%).As the time of discharge from hospital prolonged,the use proportion of secondary prevention medications were gradually declining.1 year after discharge.,patients were prescribed the following:aspirin 566 cases(92.0%),the P2Y12 receptor inhibitors 531 cases(86.3%),statin 497 cases(80.8%)?p-blockers 321 cases(52.2%),ACEI/ARB 214 cases(34.8%).The proportion of P-blockers decreasing was the most dramatical(21.8%).The primary endpoint was major adverse cardiac events(MACE)defined as all-cause mortality,non-fatal myocardial infarction,non-fatal stroke,recurrent angina,cardiac arrest and rehospitalization for cardiovascular disease.During the follow-up of 1 year,101(16.4%)patients experienced MACE.MACE in standard group were significantly lower than that in non-canonical group(12.8%vs19.6%,p=0.022),Among of MACE,the rate of recurrent angina and rehospitalization for cardiovascular disease in standard group were lower than that in non-standard group(6.4%vs11.6%,p=0.024;7.4%vs12.3%,p:=0.044),as well as there were statistical differences between two groups.Although all-cause mortality(1.0%vs1.9%,p=0.366),non-fatal myocardial infarction(2.0%vs4.1%,p=0.139),non-fatal stroke(0.3%vs0.6%,p=0.333),and cardiac arrest(0.0%vs0.3%,p=0.333)were all no significant statistical difference between the two groups(p>0.05).The absolute numbers in standard group were significantly less compared with the non-standard group.Among of gender,age,marital status,educational level,pay methods,complications,treatment approaches,disease types,stent numbers,occupation and types of medication,the marital status,type of treatment approach,the type of disease and the kinds of drugs were relevant to patients adherence by the multivariate Logistic regression analysis.Conclusions:There are gaps between the use of evidence-based secondary prevention medications at discharge in patients with acute coronary syndrome undergoing percutaneous coronary intervention and the guidelines recommendation.As the time of discharge prolong,patients compliance also decrease.Enhancing ACS patients compliance after PCI can reduce the incidence of major adverse cardiovascular events. |
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